本研究從角色間衝突的觀點，來探討醫師面對所處的醫療環境而產生的衝突對滿足以及離職傾向的影響。本研究除探討導致醫師雙重專業衝突的衝突源，並發展衝突源及其相關的量表，進一步瞭解醫師雙重專業衝突對滿足及離職傾向的影響，同時檢測醫師的滿足在其雙重專業衝突與離職傾向之間的中介效果，並驗證專業承諾對醫師的雙重專業衝突及其後果變項間的調節關係。醫療保險給付制度的變化，帶給各級醫療院所經營管理上莫大的衝擊，影響醫師的照護行為，並引起醫師的組織-專業衝突及個人-專業衝突。過往較缺乏對醫師角色間衝突的研究，尤其是對引起醫師組織-專業衝突與個人-專業衝突其衝突源的探討，台灣的總額預算支付制度是台灣健保的特色，既有的文獻並不足以探究出造成醫師組織-專業衝突與個人-專業衝突的原因，及其相關的後果，本研究首先進行個案訪談，並將整理的分析結果配合文獻發展成量表，據而建立研究假設，再收集實證調查資料進行驗證，希望結合質化與量化的研究在調查研究結果的分析與討論上，可以更深入且精確。
本研究的實證調查研究共發出1,200份問卷，有效問卷776份，以在地區醫院層級以上的醫療院所任職的住院醫師階級以上的醫師為研究對象，問卷發放的區域遍及北、中、南及東部地區的公私立醫院。以探索性因素分析及驗證性因素分析共得到五個衝突源的變數，經由相關分析結果發現五個衝突源皆與醫師的雙重專業衝突達到顯著的關聯；並藉由迴歸分析驗證，確認專業承諾的情感性承諾、持續性承諾及規範性承諾等三構面對醫師的雙重專業衝突及其後果變項間具顯著的調節效果；同時透過結構方程模式的分析，結果顯示，醫師的內在滿足與外在滿足對組織-專業衝突及離職傾向之間具有完全的中介效果，醫師的專業滿足則對個人-專業衝突及離職傾向之間具有部分的中介效果。
醫師為另一個非常重要的專業族群，健康保險政策的改變是全世界的現象，但較缺乏探討台灣醫師的角色間衝突，本研究應有助於填補這方面的缺口；另本研究發展醫師雙重專業衝突之衝突源及其他相關變項問卷，並確認專業承諾的調節效果與滿足的中介作用，應可提供實務上的參考及後續研究的基礎。

From the point of view of interrole conflict, this study probes into the conflict that a physician encounters in his/her environment and the subsequent conflict effect on the satisfaction and intention to quit. In addition to investigating the source of conflict, the study develops a questionnaire to understand the influence of dual professional conflict on satisfaction and intention to quit. Simultaneously, the study examines the mediating effect of physician's satisfaction on dual professional conflict and intention to quit, and tests the moderating effect of professional commitment on other consequences.
The rapid changes of healthcare insurance policy in Taiwan have a great impact on the hospital administration. In addition, it has a tremendous influence on physician’s behaviors, which arouse conflicts on both organizational-professional (OPC) and personal-professional (PPC) levels. In the past, there were few research on interrole conflict, especially on the source of physicians' OPC and PPC. Taiwan’s national health insurance and global budget system is unique (to) healthcare insurance system in the worldwide(Taiwan).Literatures are not enough to offer the cause of the dual conflicts of physicians and relevant consequences. The study, first, carries on case interview in accordance with literature review to form questionnaires and builds up hypotheses. Second, it collects the survey materials by combining quantitative and qualitative research in order to obtain a deeper and more accurate analysis of the study results.
Physician including residents and attending physician from both public and private hospitals in Taiwan were enrolled for study. A total of 1,200 questionnaires were distributed and 776 were valid questionnaires.
The result shows five variables in the source of conflict by using exploratory factor analysis (EFA) and confirmatory factor analysis (CFA). These five variables are significantly correlated with physician’s dual professional conflicts. Results from regression analysis show that affective commitment, continuance commitment and normative commitment of professional commitment have a moderating effect on the relationship between dual professional conflicts and the output variables. Furthermore, by structural equation modeling these results show that both internal and external job satisfaction mediate between physicians’ OPC and their intention to quit, and professional satisfaction partially mediate between physicians’ PPC and their intention to quit.
Physicians are one of the important professional groups. Even though changes in healthcare insurance policy are worldwide phenomenon, there is relatively few studies probing into interrole conflict among physicians in Taiwan. This study developed questionnaires of the source of conflict and confirmed both the moderating effect of professional commitment and the mediating effect of satisfaction, which contributes to fill the gap in this field. These results provide a managerial reference in clinical practice and as well as a foundation of future studies.

目 錄
第一章 緒論 1
第一節 研究背景 1
第二節 研究動機 5
第三節 研究目的 8
第二章 文獻探討 10
第一節 專業人員 10
第二節 醫師雙專業衝突 12
第三節 醫師雙專業衝突、工作滿足、專業滿足及離職傾向 32
第四節 專業承諾 39
第三章 質性研究-個案訪談 45
第一節 研究設計 45
第二節 個案訪談整理分析及量表的編製 47
第四章 實證調查研究 78
第一節 研究設計 78
第二節 研究對象 81
第三節 研究變項與衡量工具 83
第四節 實證研究結果 130
第五章 結論與建議 165
第一節 結論 165
第二節 研究貢獻與研究限制 168
第三節 建議 170
參考文獻 172
附錄一、訪談題目 192
附錄二、研究問卷 193

表 目 錄
表1-1全民健康保險各部門總額各季點值一覽表 4
表 3-1訪談對象 46
表3-2「組織的政策」測量題項 54
表3-3「績效薪資」測量題項 57
表3-4「醫病倫理觀」測量題項 61
表3-5「醫病關係的考量」測量題項 66
表3-6「金錢的追求」測量題項 70
表3-7「組織-專業衝突」測量題項 74
表3-8「個人-專業衝突」測量題項 77
表4-1本研究樣本之個人變項資料分佈表 82
表4-2樣本一之個人變項資料分析表 84
表4-3「組織的政策」因素分析 86
表4-4「績效薪資」因素分析 86
表4-5「醫病倫理觀」因素分析 87
表4-6「醫病關係考量」因素分析 88
表4-7「金錢的追求」因素分析 88
表4-8「組織-專業衝突」因素分析 89
表4-9「個人-專業衝突」因素分析 90
表4-10「情感性承諾」量表及信度分析 91
表4-11「持續性承諾」量表及信度分析 91
表4-12「規範性承諾 」量表及信度分析 92
表4-13「專業滿足」因素分析 92
表4-14「內在滿足」量表及信度分析 93
表4-15「外在滿足」量表及信度分析 94
表4-16「離職傾向」因素分析 95
表4-17樣本二之個人變項資料分佈表 97
表4-18「組織的政策」模式之適配考驗指標 99
表4-19「組織的政策」修正後模式之參數估計表 100
表4-20「組織的模式」修正後模式之題項、建構信度、平均變異
抽取量、相關與區別效度 100
表4-21「績效薪資」模式之適配考驗指標 101
表4-22「績效薪資」修正後模式之參數估計表 102
表4-23「績效薪資」修正後模式之題項、建構信度、平均變異
抽取量、相關與區別效度 102
表4-24「醫病倫理觀」模式之適配考驗指標 103
表4-25「醫病倫理觀」修正後模式之參數估計表 104
表4-26「醫病倫理觀」修正後模式之題項、建構信度與平均變異
抽取量 104
表4-27「醫病關係考量」模式之適配考驗指標 105
表4-28「醫病關係考量」修正後模式之參數估計表 106
表4-29「醫病關係考量」修正後模式之題項、建構信度與平均變
異抽取量 106
表4-30「金錢的追求」模式之適配考驗指標 107
表4-31「金錢的追求」修正後模式之參數估計表 108
表4-32「金錢的追求」修正後模式之題項、建構信度與平均變異
抽取量、相關與區別效度 108
表4-33「組織-專業衝突」模式之適配考驗指標 110
表4-34「組織-專業衝突」修正後模式之參數估計表 110
表4-35「組織-專業衝突」修正後模式之題項、建構信度與平均變
異抽取量 111
表4-36「個人-專業衝突」模式之適配考驗指標 112
表4-37「個人-專業衝突」修正後模式之參數估計表 112
表4-38「個人-專業衝突」修正後模式之題項、建構信度與平均變
異抽取量 113
表4-39「情感性承諾」模式之適配考驗指標 114
表4-40「情感性承諾」修正後模式之參數估計表 114
表4-41「情感性承諾」修正後模式之題項、建構信度與平均變異
抽取量 115
表4-42「持續性承諾」模式之適配考驗指標 116
表4-43「持續性承諾」修正後模式之參數估計表 116
表4-44「持續性承諾」修正後模式之題項、建構信度與平均變異
抽取量 116
表4-45「規範性承諾」模式之適配考驗指標 117
表4-46「規範性承諾」修正後模式之參數估計表 118
表4-47「規範性承諾」修正後模式之題項、建構信度與平均變異
抽取量 118
表4-48「專業滿足」模式之適配考驗指標 119
表4-49「專業滿足」修正後模式之參數估計表 120
表4-50「專業滿足」修正後模式之題項、建構信度與平均變異
抽取量 120
表4-51「內在滿足」模式之適配考驗指標 121
表4-52「內在滿足」修正後模式之參數估計表 121
表4-53「內在滿足」修正後模式之題項、建構信度與平均變異
抽取量 122
表4-54「外在滿足」模式之適配考驗指標 123
表4-55「外在滿足」修正後模式之參數估計表 123
表4-56「外在滿足」修正後模式之題項、建構信度與平均變異
抽取量 124
表4-57「離職傾向」模式之適配考驗指標 125
表4-58「離職傾向」修正後模式之參數估計表 125
表4-59「離職傾向」修正後模式之題項、建構信度與平均變異
抽取量 125
表4-60衝突源各變數修正後結果之適配考驗指標 128
表4-61衝突源各變數的建購信度與平均變易抽取量 128
表4-62雙專業衝突、滿足、專業承諾與離職傾向各變數配考驗
指標 129
表4-63雙專業衝突、滿足、專業承諾與離職傾向的建構信度與平
均變異抽取量 129
表4-64各研究變數的平均數、標準差與相關係數 131
表4-65主治醫師與住院醫師之衝突源各變數對「組織-專業衝突」
之迴歸分析 133
表4-66主治醫師與住院醫師之衝突源各變數對「個人-衝突衝突」
之迴歸分析 134
表4-67醫師「專業承諾」與「組織-專業衝突」對「專業滿足」
的迴歸和交互作用分析 143
表4-68醫師「專業承諾」與「組織-專業衝突」對「內在滿足」
的迴歸和交互作用分析 144
表4-69醫師「專業承諾」與「組織-專業衝突」對「外在滿足」
的迴歸和交互作用分析 145
表4-70醫師「專業承諾」與「組織-專業衝突」對「離職傾向」
的迴歸和交互作用分析 146
表4-71醫師「專業承諾」與「組織-專業衝突」對「專業滿足」
的迴歸和交互作用分析 147
表4-72醫師「專業承諾」與「組織-專業衝突」對「內在滿足」
的迴歸和交互作用分析 148
表4-73醫師「專業承諾」與「個人-專業衝突」對「外在滿足」
的迴歸和交互作用分析 149
表4-74醫師「專業承諾」與「個人-專業衝突」對「離職傾向」
的迴歸和交互作用分析 150
表4-75專業滿足、內在滿足、外在滿足對醫師雙專業衝突及離職
傾向間的中介效果之適配考驗指標 154
表4-76專業滿足對雙專業衝突與離職傾向中介模式之潛在變項對
觀察變項參數估計表 156
表4-77專業滿足對雙專業衝突與離職傾向中介模式潛在變項之建
構信度與平均變異的抽取量 156
表4-78專業滿足對雙專業衝突與離職傾向中介模式之潛在變項與
潛在變項間參數估計表 157
表4-79專業滿足對雙專業衝突與離職傾向中介模式之潛在變項與
潛在變項間各項標準化效果 157
表4-80內在滿足對雙專業衝突與離職傾向中介模式之潛在變項對
觀察變項參數估計表 158
表4-81內在滿足對雙專業衝突與離職傾向中介模式之潛在變項之
建構信度與平均變異抽取量 159
表4-82內在滿足對雙專業衝突與離職傾向中介模式之潛在變項與
潛在變項間參數估計表 159
表4-83內在滿足對雙專業衝突與離職傾向中介模式之潛在變項與
潛在變項間各項標準化效果 159
表4-84外在滿足對雙專業衝突與離職傾向中介模式之潛在變項對
觀察變項參數估計表 161
表4-85外在滿足對雙專業衝突與離職傾向中介模式之潛在變項之
建構信度與平均變異抽取量 162
表4-86外在滿足對雙專業衝突與離職傾向中介模式之潛在變項與
潛在變項間參數估計表 162
表4-87外在滿足對雙專業衝突與離職傾向中介模式之潛在變項與
潛在變項間各項標準化效果 162
表4-88醫師雙專業衝突、滿足、專業承諾與離職傾向之間的關係
整理表 164


圖 目 錄
圖1-1台灣平均國民醫療保健支出(美元係依當年匯率換算)和醫療保
健總支出佔國內生產毛額百分比的趨勢 2
圖2-1 Chang & Cheung(2001)源自Triandis(1979)的選擇模型 20
圖2-2 Gagnon,et al.,(2003)根據1980年Triandis的理論的觀念架構 21
圖4-1研究架構 78
圖4-2「組織的政策」修正後之標準化參數估計值 99
圖4-3「績效薪資」修正後之標準化參數估計值 101
圖4-4「醫病倫理觀」修正後之標準化參數估計值 103
圖4-5「醫病關係考量」修正後之標準化參數估計值 105
圖4-6「金錢的追求」修正後之標準化參數估計值 107
圖4-7「組織-專業衝突」修正後之標準化參數估計值 109
圖4-8「個人-專業衝突」修正後之標準化參數估計值 111
圖4-9「情感性承諾」修正後之標準化參數估計值 114
圖4-10「情感性承諾」修正後之標準化參數估計值 115
圖4-11「規範性承諾」修正後之標準化參數估計值 117
圖4-12「專業滿足」修正後之標準化參數估計值 119
圖4-13「內在滿足」修正後之標準化參數估計值 121
圖4-14「外在滿足」修正後之標準化參數估計值 123
圖4-15「離職傾向」修正後之標準化參數估計值 124
圖4-16情感性承諾與組織-專業衝突對專業滿足的交互作用 151
圖4-17情感性承諾與組織-專業衝突對內在滿足的交互作用 151
圖4-18情感性承諾與組織-專業衝突對外在滿足的交互作用 151
圖4-19情感性承諾與組織-專業衝突對離職傾向的交互作用 151
圖4-20情感性承諾與個人-專業衝突對專業滿足的交互作用 151
圖4-21情感性承諾與個人-專業衝突對內在滿足的交互作用 151
圖4-22情感性承諾與個人-專業衝突對外在滿足的交互作用 152
圖4-23情感性承諾與個人-專業衝突對離職傾向的交互作用 152
圖4-24持續性承諾與組織-專業衝突對外在滿足的交互作用 152
圖4-25持續性承諾與組織-專業衝突對專業滿足的交互作用 152
圖4-26持續性承諾與個人-專業衝突對外在滿足的交互作用 152
圖4-27規範性承諾與組織-專業衝突對專業滿足的交互作用 152
圖4-28規範性承諾與組織-專業衝突對內在滿足的交互作用 152
圖4-29規範性承諾與組織-專業衝突對外在滿足的交互作用 152
圖4-30規範性承諾與組織-專業衝突對離職傾向的交互作用 152
圖4-31規範性承諾與個人-專業衝突對專業滿足的交互作用 152
圖4-32規範性承諾與個人-專業衝突對內在滿足的交互作用 152
圖4-33規範性承諾與個人-專業衝突對外在滿足的交互作用 152
圖4-34規範性承諾與個人-專業衝突對離職傾向的交互作用 154
圖4-35專業滿足對組織-專業衝突、個人-專業衝突與離職傾向之中介
模式的標準化估計 155
圖4-36內在滿足對組織-專業衝突、個人-專業衝突與離職傾向之中介
模式的標準化參數估計 160
圖4-37外在滿足對組織-專業衝突、個人-專業衝突與離職傾向之中介
模式的標準化參數估計 163

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